How do occupational therapists test for retained reflexes in children?
Learn how occupational therapists assess retained primitive reflexes in children through simple movement activities, identify signs that may affect handwriting, posture and coordination, and understand when an occupational therapy evaluation may help.
When an occupational therapist tests for retained reflexes, they basically ask your child to do simple, gentle physical movements like turning their head, curling up like a bug, or getting on hands and knees and watching how their body reacts. We want to see if early baby reflexes are still switching on automatically when they shouldn't be. The check is completely painless, feels like a game, and helps us figure out why things like sitting straight at a desk or holding a pencil feel so exhausting for your child.
What are primitive reflexes anyway?
Think of primitive reflexes as little built-in survival buttons we are all born with. When a tiny newborn turns their head to one side, their little arm on that same side shoots straight out. It happens on pure instinct. Nobody teaches them to do it.
As babies grow, their brain takes over the steering wheel. Those automatic baby reactions are supposed to pack up and go to sleep, what therapists call 'integrating'.
But sometimes they just don't fade away like they should.
When these infant reflexes hang around past toddlerhood, we call them retained primitive reflexes. And honestly, it means your child's body is still fighting automatic baby movements while trying to do big-kid things. Sitting still on a classroom chair, copying words off the whiteboard, or even holding a pencil without cramping up suddenly takes twice as much energy. It is exhausting work for them.
A quick example from everyday life
Example: Picture an eight-year-old sitting at school. Every time they turn their head to look up at the teacher, their elbow wants to bend on its own or their body twists sideways. Their hand slips across the page, their notebook slides, and they end up slumping right over the desk.
To a teacher or parent, it might look like daydreaming or lazy posture. But during an evaluation, when the therapist asks them to stand up, close their eyes, and slowly turn their head left and right, their arms start drifting out of place without them realising it. That tells us the Asymmetrical Tonic Neck Reflex (ATNR) is still active. The child is trying their best, their nervous system is just firing an old infant reflex.
What happens during the assessment?
Nothing here hurts. Most kids just think we are playing silly movement games. Here is what we are usually watching for:
The head-turn check (ATNR), cat-and-cow check (STNR), 'Superman' and 'turtle' poses (TLR), startle check (Moro Reflex), palm check (Palmar Grasp).
Helpful things parents can do at home
| Keep a quiet eye on daily habits | Notice if your child slumps constantly, struggles with bike pedals, gets carsick easily, or covers their ears at normal noises. |
| Take a quick phone video | If you catch an awkward pencil grip or weird sitting posture at home, film a ten-second clip. It gives your therapist great clues. |
| Skip random internet exercise plans | Please do not try unguided exercise videos you find online. If movements are not matched to your child's exact profile, it can make them feel frustrated or overwhelmed. |
| Book a proper occupational therapy check | A licensed therapist looks at reflexes alongside sensory processing, motor planning, and everyday school skills. |
When is it worth getting checked?
An occupational therapy evaluation may be helpful if everyday motor tasks still feel like an uphill battle despite plenty of practice and patience.
Maybe your child trips over their own feet a lot. Maybe their hand aches after writing just two lines, or they cannot sit still without leaning their whole weight on the table. An assessment simply tells us what is going on underneath, whether it is retained reflexes, weak core muscles, sensory differences, or a mix of things.
Common reflexes at a glance
| Reflex Name | When it usually fades | How we check it | What you might notice at home or school |
| Asymmetrical Tonic Neck Reflex (ATNR) | 6 to 7 months | Turning the head while standing or on hands and knees | Messy handwriting, slumping when looking at the board, trouble crossing the body midline |
| Symmetrical Tonic Neck Reflex (STNR) | 9 to 11 months | Looking up and down on hands and knees | W-sitting on the floor, slouching at desks, clumsy crawling or swimming |
| Tonic Labyrinthine Reflex (TLR) | 3 to 4 years | Superman pose on the tummy or curling on the back | Toe walking, floppy posture, poor balance, bumping into furniture |
| Moro (Startle) Reflex | 4 to 6 months | Gentle backward tilt or sudden sensory sound | Big meltdowns, car sickness, jumpiness, sensitivity to bright lights or loud sounds |
| Palmar Grasp Reflex | 4 to 6 months | Gentle stroke across the palm while using fingers | Super tight pencil grip, hand getting tired fast, moving mouth while using scissors |
Our clinical perspective
We never look at reflexes in a vacuum. An active reflex is just one small piece of a much wider picture that includes core stability, sensory processing, and how confident a child feels in their body. Our goal is never to 'fix' a child like a mechanical object. We just want to make moving, writing, and playing feel easier so your child can enjoy their day without feeling wiped out by lunch time.
Here in Dubai
In Dubai, pediatric occupational therapists practise under licensing and clinical guidelines set by the Dubai Health Authority (DHA). Our multidisciplinary teams work closely with international curricula schools across the UAE, where dual-language learning and full desk days put high demands on posture, handwriting, and visual tracking.
Nutan Dhamale
B.O.TH
Head of Occupational Therapy Dept.
I am Nutan, Head of the Occupational Therapy Department at Bridges Speech Center. I hold a Bachelor’s degree in Occupational Therapy from Seth G.S. Medical College and KEM Hospital in India, and I have more than 10 years of experience working with children.
I enjoy helping children become more comfortable and confident in the activities that fill their day, playing, getting dressed, eating, writing, and joining in at school. I take time to understand each child’s strengths and challenges, then work with parents and educators on practical strategies they can use beyond the therapy room.
My work includes supporting children with autism, ADHD, developmental delays, learning difficulties, and sensory processing challenges. I have training in sensory integration, reflex integration, Handwriting Without Tears, feeding difficulties, and neurodevelopmental therapy. I use individual goals and play-based activities to help each child build skills at their own pace.
If your child is finding everyday activities, sensory experiences, handwriting, or feeding difficult, an occupational therapy assessment can help identify their strengths and the support they need.
To schedule a consultation, contact Bridges Speech Center LLC:
04 358 1115 | 050 522 6054
References
- American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process—Fourth edition. American Journal of Occupational Therapy, 74(Supplement 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001
- American Occupational Therapy Association. (n.d.-a). Early intervention. https://www.aota.org/practice/practice-settings/schools-early-intervention-community-education/early-intervention
- American Occupational Therapy Association. (n.d.-b). Practice guidelines and evidence-based clinical resources. https://www.aota.org/practice/practice-essentials/evidencebased-practiceknowledge-translation/practice-guidelines
- American Occupational Therapy Association. (n.d.-c). School-based settings. https://www.aota.org/practice/practice-settings/schools-early-intervention-community-education/schools
- Royal College of Occupational Therapists. (n.d.). Occupational therapy for children and young people. https://www.rcot.co.uk/explore-resources/children-young-people-families/OT-children-and-young-people